ALCOHOL USE DISORDER AND LIVER FIBROSIS

According to the National Institute on Alcohol Abuse and Alcoholism, “alcohol use disorder (AUD) is a medical condition characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences.” It’s considered a brain disorder and describes what is often referred to as alcohol abuse, alcohol dependence, alcohol addiction, or alcoholism.

The Canadian Centre on Substance Use and Addiction has updated their recommendations for low-risk alcohol use. They recommend 1-2 standard drink per week. Standard drink amounts include:

• Beer: 341 ml (12 oz) of beer 5% alcohol
• Cooler, cider, ready-to-drink: 341 ml (12 oz) of drinks 5% alcohol
• Wine: 142 ml (5 oz) of wine 12% alcohol
• Spirits: 43 ml (1.5 oz) of spirits 40% alcohol

Prolonged and heavy use of alcohol can lead to alcohol-associated liver disease (ALD). This common complication associated with AUD may start with a buildup of excess fat in the liver – called hepatic steatosis – which occurs in 90% to 95% of patients with chronic, heavy alcohol use.

Your liver is the second largest organ in your body. It helps process nutrients and filters harmful substances from your blood. When fat builds up in the liver it can cause inflammation and lead to scarring.

Liver fibrosis is the first stage of liver scarring and can occur in 20-40% of AUD patients. As liver fibrosis progresses, the liver tissue becomes stiffer and may eventually lead to the end stage, referred to as cirrhosis.

WHAT ARE THE RISK FACTORS FOR LIVER DISEASE?

With mild to moderate liver fibrosis, many people do not experience symptoms. As such, it can be challenging to diagnose chronic liver disease. In addition to results from blood tests, your health care practitioner might look at the following risk factors, which can increase your risk for ALD:

• Female sex
• Obesity
• Diet – eating foods high in fat, sugar, and salt
• Certain genetic susceptibilities
• Harmful patterns of alcohol consumption
• Smoking
• Other liver conditions, such as viral hepatitis, hemochromatosis, and HIV

Chronic liver disease can severely affect the function of your liver, but early diagnosis can limit further damage.

HOW IS LIVER FIBROSIS DIAGNOSED?

A type of ultrasound imaging called liver elastography directs painless low frequency vibrations into the liver to measure how quickly these vibrations move through it. A computer uses this information to create a visual map showing the stiffness of the liver. This exam is the same as an abdomen ultrasound with the use of elastography technology at the end of the exam.

By measuring the stiffness of your liver, elastography is an appropriate tool to look for the variety of diseases that can occur in the liver and:

• Detect and assess the severity of liver disease.
• Determine the risk or presence of complications of liver disease.
• Guide treatment decisions.
• Monitor your response to treatment.

Traditionally, liver fibrosis was assessed with biopsy – a needle was used to take a small sample of your liver tissue for examination under a microscope. However, this invasive technique can be associated with complications and can only sample a small portion of the liver.

HOW DO I GET AN ELASTOGRAPHY ULTRASOUND?

Ultrasound helps health care practitioners make a diagnosis and inform care decisions. Once your doctor has identified the need for this exam, your doctor’s office may book an appointment for you, or provide you with a number to call to book your appointment. You will also be given a requisition form and preparation instructions for your exam.

For liver elastography ultrasound, you will be asked to fast and have nothing to eat or drink (except water) for six hours prior to your exam. It generally takes between 20-30 minutes to complete this exam.

Once in the exam room you may be asked to change into a gown. You will then be positioned by one of our compassionate and experienced sonographers. A warm, unscented, hypo-allergenic, water-based ultrasound gel will be applied to your abdomen, and your sonographer will move the transducer around the front and side of your abdomen and ribcage to gather images of your organs. You may be asked to hold your breath and change position to help better examine the area of concern. You may experience mild to moderate pressure while the sonographer takes the images.

Mayfair Diagnostics participated in the development of a regional enhanced primary care pathway for AUD and liver elastography exams are used in accordance with that pathway.

WHAT HAPPENS AFTER MY EXAM?

Your images will be reviewed by a specialized radiologist who will compile a report that is sent to your doctor within 24 hours, sooner for urgent requests. Mayfair Diagnostics is owned and operated by over 50 radiologists who are fellowship-trained in many key areas, such as neuroradiology, body, cardiac, musculoskeletal, etc. This allows for an expert review of your imaging by the applicably trained radiologist.

Your images will be uploaded to a provincial picture archiving and communication system (PACS) – this technology provides electronic storage and convenient access to your medical images from multiple sources, such as your doctor, specialists, hospitals, and walk-in clinics.

Your doctor will review your images and the report from the radiologist and discuss next steps with you, such as a treatment plan or the need for further diagnostic imaging or lab tests to ensure an accurate diagnosis.

Our elastography services are available at our Castleridge, Coventry Hills, Mahogany Village, and Market Mall locations in Calgary, and our Regina location in Saskatchewan. For more information about our clinic locations and services, please visit our clinic location pages.

REFERENCES

Alberta Health Services (2023) “Primary Care Pathway: Alcohol Use Disorder (AUD).” www.specialistlink.ca. Accessed October 3, 2023.

American Liver Foundation (2023) “Liver Disease Diets.” www.liverfoundation.org. Accessed September 25, 2023.

Canadian Centre on Substance Use and Addiction (2023) “Canada’s Guidance on Alcohol and Health: Final Report.” www.ccsa.ca. Accessed October 3, 2023.

Gherlan, G. S. (2015) “Liver ultrasound elastography: More than staging the disease.” World Journal of Hepatology. Accessed September 25, 2023.

Nall, R. & Cherney, K. (2023) “Liver Fibrosis.” www.healthline.com. Accessed September 25, 2023.

National Institute on Alcohol Abuse and Alcoholism (2023) “Understanding Alcohol Use Disorder.” www.niaaa.nih.gov. Accessed September 25, 2023.

Radiological Society of North America (2022) “Elastography.” www.radiologyinfo.org. Accessed September 25, 2023.

Ramkissoon, R. & Shah, V.H. (2022) “Alcohol Use Disorder and Alcohol-Associated Liver Disease.” Alcohol Research. 2022; 42(1): 13. Accessed September 25, 2023.